Secrets, lies, and cover-ups

August 2017 Vol. 12 No. 8

The impact of the new healthcare bill can’t be hidden forever.

By Leah Curtin, RN, ScD(h), FAAN

As Newton observed, for every action in nature there’s an equal and opposite reaction. So too with laws that are hastily written and enacted. The Senate healthcare bill was developed secretly by 13 senators, reportedly with input from large pharmaceutical company lobbyists. Some commentators report that the bill will eliminate a huge chunk of government spending for hospitals and for insurance, pharmaceutical, and biotechnology companies. Others say no reduction in government spending will occur, but growth will slow. The Congressional Budget Office indicates that about 22 million people will eventually lose health insurance—with about 15 million of those from 2018 to 2019. This loss of coverage will largely be the result of gutting Medicaid.

When patients don’t have insurance coverage, either from Medicaid or private insurance, their access to medical care is severely reduced to little more than emergency department visits, for which the hospital receives no revenue when patients can’t afford to pay. This resulting loss in revenue must be absorbed by other patients. Subsequently, insurance rates for all health insurance subscribers are likely to rise. The Hospital Corporation of America, the formal name of HCA Healthcare, derives 3.8% of its $41.49 billion in annual revenue from Medicaid. But the loss from even a portion of Medicaid-funded revenue could be greater than 3.8% because hospitals not only stand to lose revenue, but they also incur greater costs.

Secrets…

People hide secrets two ways. They either make them “true” unconsciously through rationalization (something like, keeping the secret is good for others, good for the Party, enables progress on our legislative efforts, etc.) or by lying. Experts also tell us that we keep secrets to cover up poor choices and avoid the consequences if people find out the truth. We may be ashamed of what we’ve done, or we may not be able to correct the problem. I tend to think that the senators who crafted the American Health Care Act (AHCA) can’t correct the problems with it and stay true to their political beliefs, which includes believing that it’s not government’s function to provide citizens with entitlement programs.

Lies…

Secrets always—not sometimes, but always—lead to lies. And without a doubt these lies will be discovered because health care affects all our lives in real ways. Make no mistake about it; we will find out the truth eventually: financially, socially, and morally. So, this secret can’t remain a secret, and these lies are only stop-gap measures.

Cover-ups…

If somehow the AHCA passes, the rollout of the new legislation would be staggered so that the true initial impact on individuals and healthcare sector companies won’t be felt until January 2019, which is conveniently after the 2018 congressional elections. Other major aspects of the bill won’t be felt until 2021, after the next presidential elections.

Any legislation passed by the Senate would need to be reconciled with the House version before it can be sent to the president’s desk to be signed into law.